The usefulness of liposomal bupivacaine to reduce pain scores, postoperative opioid use, early mobility, and length of stay is not well-established for major spine surgeries. (C, Class III)

Wound infiltration with local anesthetic may be considered part of a multimodal pain regimen to reduce postoperative pain, PONV, and length of hospital stay. (B-R, Class IIa)

Patient-controlled analgesia may be considered as part of a postoperative multimodal analgesic regimen. (B-R, Class IIb)

After careful patient selection, cyclooxygenase inhibitors may be considered in the perioperative period to reduce postoperative pain. (B-R, Class IIb)

The routine administration of perioperative acetaminophen for postoperative pain as a part of a multimodal analgesia regimen is not well-established. (B-NR, Class IIb)

To reduce opioid consumption in the immediate postoperative period and considering the potential for long-lasting analgesic effects, an infusion of ketamine in the perioperative period (initiated in the intraoperative period and continued into the postoperative period) may be reasonable. (B-R, Class IIb)

The usefulness of routine use of perioperative gabapentinoids in multimodal analgesic regimen is not well-established. (B-R, Class III)

A multimodal approach to PONV prophylaxis is indicated in all patients undergoing complex spine surgeries. (B-R, Class I)

Preoperative and intraoperative factors may be considered when planning patient admission to the ICU or floor/ward. (B-NR, Class IIb)

We suggest to avoid hypotensive episodes (MaP lower than 65 mmHg). (2C)